Borges-Rosa João, Oliveira-Santos Manuel, Silva Rodolfo, Gomes Andreia, de Almeida José, Costa Gracinda, Gonçalves Lino, Ferreira Maria João
Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
Int J Cardiol. 2022 Jan 15;347:38-43. doi: 10.1016/j.ijcard.2021.10.157. Epub 2021 Nov 1.
Cardiac sarcoidosis (CS) is clinically diagnosed in 5% of patients with sarcoidosis but imaging studies suggest higher prevalence. We evaluated the prevalence, clinical manifestations, and cardiovascular outcomes of CS, diagnosed through F-Fluorodeoxyglucose positron emission tomography ([F]FDG-PET), in a southern European population.
Retrospective single-centre study of patients screened for sarcoidosis with [F]FDG-PET. Subjects with histological confirmation were divided in two groups, CS or extracardiac sarcoidosis, according to Heart Rhythm Society's criteria. Primary endpoint was defined as the composite of heart failure hospitalizations, uncontrolled arrythmias, pacemaker implantation, and cardiovascular (CV) mortality. Secondary outcomes included each component and all-cause mortality.
From 128 patients with biopsy-proven extracardiac sarcoidosis, 10.2% had probable CS, 54% without symptoms of cardiac involvement. Ten patients had suggestive [F]FDG uptake patterns, three subjects had an indicative cardiac magnetic resonance (CMR). Patients with probable CS had significantly higher prevalence of coronary and valvular disease, heart failure, and atrial fibrillation compared with those without cardiac involvement. During a mean follow-up of 4.0 SD2.7 years, the primary outcome occurred more frequently in patients with probable CS (53.8% vs. 3.5%; HR 25.45; 95% CI 5.27-122.9; p < 0.01) as well as heart failure hospitalizations (46.2% vs. 0.9%), uncontrolled arrhythmias (23.1% vs. 1.7%) and pacemaker implantation (23.1% vs. 0.9%) (p < 0.01 for all). All-cause mortality was three-fold higher in probable CS, despite the absence of statistical significance (15% vs. 5%, p = 0.15).
Among patients with biopsy-proven sarcoidosis, cardiac involvement detected by [F]FDG-PET or CMR is associated with a higher risk of CV events, irrespective of symptoms.
心脏结节病（CS）在结节病患者中的临床诊断率为5%，但影像学研究表明其实际患病率更高。我们评估了通过F-氟脱氧葡萄糖正电子发射断层扫描（[F]FDG-PET）诊断的CS在南欧人群中的患病率、临床表现和心血管结局。
对接受[F]FDG-PET筛查的结节病患者进行回顾性单中心研究。根据心律协会的标准，组织学确诊的受试者分为两组，即CS组或心脏外结节病组。主要终点定义为心力衰竭住院、心律失常未控制、起搏器植入和心血管（CV）死亡的综合情况。次要结局包括每个组成部分和全因死亡率。
在128例经活检证实为心脏外结节病的患者中，10.2%可能患有CS，54%无心脏受累症状。10例患者有提示性的[F]FDG摄取模式，3例患者有指示性心脏磁共振成像（CMR）。与无心脏受累的患者相比，可能患有CS的患者冠状动脉和瓣膜疾病、心力衰竭及心房颤动的患病率显著更高。在平均4.0±2.7年的随访期间，主要结局在可能患有CS的患者中更频繁出现（53.8%对3.5%；风险比25.45；95%置信区间5.27-122.9；p<0.01），心力衰竭住院（46.2%对0.9%）、心律失常未控制（23.1%对1.7%）和起搏器植入（23.1%对0.9%）（所有p值均<0.01）。尽管无统计学意义，但可能患有CS的患者全因死亡率高出三倍（15%对5%，p=0.15）。
在经活检证实的结节病患者中，无论有无症状，通过[F]FDG-PET或CMR检测到的心脏受累与心血管事件风险较高相关。
